Hospital volume and operative mortality in cancer surgery

Operative mortality decreases with increasing hospital volume for several cancer resection procedures, find investigators in the July issue of the Archives of Surgery.

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The relative importance of volume in cancer surgery is disputed.

In this study, a team of investigators examined surgical mortality with cancer resections in the US population. They aimed to quantify the influence of hospital volume.

The team collected information from the all-payer Nationwide Inpatient Sample, between 1995 and 1997. They evaluated 195,152 cases.

They divided patients into 3 volume groups based on hospital procedure volume. Then the team used regression analysis to assess relationships between hospital volume and in-hospital mortality, adjusting for patient characteristics.

The researchers found that there was a trend toward lower operative risks at high-volume hospitals, for 7 of the 8 procedures studied.

The effect of volume was greatest in elderly patients.

Archives of Surgery

However, the differences in mortality between low- and high-volume hospitals were only statistically significant for esophagectomy, pancreatic resection, and pulmonary lobectomy.

For gastrectomy, cystectomy, and pneumonectomy absolute differences in mortality between low- and high-volume hospitals were greater than 1%, but were not statistically significant.

Mortality reductions for nephrectomy and colectomy were small.

The team determined that the effect of volume was greatest in elderly patients.